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CELC & WOW
RELENTLESS MISSION
Ministry Residency
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Travis Live
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New Here
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What We Believe
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CALENDAR
Serve
Contact
Ministries
Small Groups
Preschool
Kids
Students
College
Senior Adults
WOMEN
CELC & WOW
RELENTLESS MISSION
Ministry Residency
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Sojourn
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CELC & WOW Enrollment Form
Child's Name
*
First Name
Last Name
Child's Birthday
*
MM
DD
YYYY
Gender
*
Male
Female
Parents' Relationship to Each Other
(If unmarried, a copy of any guardianship agreement [days of visitation, etc.] must be submitted to the CELC & WOW office)
Married
Divorced
Separated
Single
Child lives with (check all that apply)
Mother and Father
Mother
Father
Other
Father's Name
First Name
Last Name
Father's Address
Street, City, Zipcode
Father's Date of Birth
MM
DD
YYYY
Father's Occupation
Father's Employer
Father's Mobile Phone
(###)
###
####
Father's Work Phone
(###)
###
####
Father's Driver's License #
Father's Email
Church Affiliation
Mother's Name
First Name
Last Name
Mother's Date of Birth
MM
DD
YYYY
Mother's Address
Street, City, Zipcode
Mother's Occupation
Mother's Employer
Mother's Mobile Phone
(###)
###
####
Mother's Work Phone
(###)
###
####
Mother's Driver's License #
Mother's Email
Church Affiliation
Check days of child's anticipated attendance
Tuesday
Wednesday
Thursday
Emergency Contact & Alternative Adults for Pick Up #1
*
List at least one local person who will be available to assume responsibility for your child in an emergency if parents cannot be reached. Photograph or DL number of approved persons must be provided to the TABC CELC office.
First Name
Last Name
Relationship to the child
Emergency Contact's Address
Street, City, Zipcode
Emergency Contact's Phone
(###)
###
####
Emergency Contact's Drivers License #
What does your child call this person?
Emergency Contact and Alternative Adult for Pick Up #2
List a second local person who will be available to assume responsibility for your child in an emergency if parents cannot be reached. Photograph or DL number of approved persons must be provided to the TABC CELC office.
First Name
Last Name
Emergency Contact's Address
Street, City, State
Emergency Contact's Phone
(###)
###
####
Emergency Contact's Drivers License #
What does your child call this person?
I give consent for the facility to secure any and all necessary emergency medical care for my child. People listed above may pick up my child.
I agree
My child has the following allergies:
The procedures to handle an allergic reaction are:
What would you want a teacher to know about your child?
Developmental Delays (if applicable):
Behavioral Issues or Suggestions for Directing Behavior:
Travis Avenue Weekday may take/print photos of my child for classroom activities and crafts.
Yes
No
Travis Avenue Weekday may use photos of my child on the private Travis Weekday Parents Facebook Page
Yes
No
I attest that the the information given in this form and all other forms for this school year are correct.
*
I agree
I understand that the monthly tuition is due on the 1st of each month and late after the 10th of each month, incurring a late fee.
*
I agree
I understand that if tuition goes more than one month late that it could result in withdrawal from the program.
*
I agree
I agree that the following electronic representation of my signature signifies that all information given in this form is true.
*
First Name
Last Name
Thank you!
